Localized juvenile spongiotic gingival hyperplasia

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a poorly understood entity and is probably a misnomer too. Although this lesion is thought to be predominantly found in young children, a significant number of cases have also been reported in adults. A 41-year-old female patient presented with an erythematous, velvety-appearing gingival mass in the mandibular anterior region. The lesion was recurrent in nature, although it was asymptomatic. A diagnosis of LJSGH was made after correlating the clinical and histopathological features. A literature search revealed that a large number of cases have been reported in adults, some as old as 87 years old. There seems to be no gender predilection, and the lesion is frequently noticed in relation to maxillary anterior gingiva. Recurrence is a characteristic feature of this lesion, although its etiology and pathogenesis are poorly understood till date. Since it has a unique behavior in terms of high recurrences, dentists and periodontists need to be made aware about spongiotic gingival hyperplasia since the lesion may be mistaken for common reactive lesions.

Management of massive peripheral ossifying fibroma using diode laser

Peripheral ossifying fibroma (POF) represents a non-neoplastic, reactive lesion of gingiva. The precise etiopathogenesis of POF is unclear; however, it is suggested to originate from the connective tissue of periodontal ligament. This lesion predominantly occurs in the maxillary anterior region. The standard treatment protocol involves surgical excision followed by the biopsy of lesion. The reactive nature and unpredictable course attribute to a high recurrence rate of the lesion; hence, proper postoperative monitoring and follow-up of the lesion are necessary. The present case was surgically managed using diode laser and did not show any sign of recurrence during the follow-up period of 6 months. Minimum intraoperative bleeding and postoperative pain, ease of operation, and patient's acceptance enable laser-assisted growth excision as a better treatment modality to other conventional surgical procedures, thus offering diode laser as a viable and effective treatment alternative in the management of massive overgrowth.

Localized Gingival Overgrowths: A Report of Six Cases

Localized gingival overgrowths are commonly encountered in our day-to-day clinical practice and often present a diagnostic dilemma to the clinicians. These lesions vary depending on the location, site, extent, histology, and/or etiopathology. Although most of the localized gingival enlargements represent the reactive lesion to plaque accumulation, the differential diagnosis ranges from peripheral fibroma to pyogenic granuloma to peripheral fibroma with ossification and/or calcification, peripheral giant cell granuloma, etc., Even the peripheral ameloblastoma may present clinically as a mere localized gingival enlargement. Therefore, proper histopathological diagnosis along with biopsy is necessary to effectively manage these lesions and to reduce their propensity for recurrence.

Pseudolymphoma versus lymphoma: An important diagnostic decision

Small innocuous growths on the face usually do not pose difficulty in diagnosis on histopathology. However, some benign inflammatory lesions might mimic malignancy and hence need further investigations for final diagnosis. The distinction between a benign/inflammatory/malignant lesion needs no emphasis as the treatment plan, prognosis and the patient's well-being depends on it. Lymphocytoma cutis, or Spiegler-Fendt Sarcoid, is classed as one of the pseudolymphomas, referring to inflammatory disorders in which the accumulation of lymphocytes on the skin resembles, clinically and histopathologically, cutaneous lymphomas. To obtain an accurate diagnosis, careful clinical evaluation, as well as histopathological and immunohistochemical examination is needed. One such case of an otherwise unassuming growth mimicking malignancy is being presented.

Unusually large-sized peripheral ossifying fibroma

Fibrous growths in the gingiva with the histopathological presence of calcifications are a common occurrence in the oral cavity. These lesions can be neoplastic in nature with either odontogenic or non odontogenic origin or they can be reactive lesions. This is a case report of an unusual presentation of peripheral ossifying fibroma , unusual because of its abnormally large size with review of literature.

Amlodipine induced plasma cell granuloma of the gingiva: A novel case report

Drug-induced gingival overgrowth (DIGO) can be a serious concern for both patients and clinicians. DIGO is a well-documented side-effect of some pharmacologic agents, including, but not limited to, calcium channel blockers, phenytoin, and cyclosporine. Plasma cell granulomas (pseudotumors) are exceedingly rare, non-neoplastic, reactive tumor-like proliferation, primarily composed of plasma cells that manifest primarily in the lungs, but may occur in various anatomic locations. Intraoral plasma cell granulomas involving the lip, oral mucosa, tongue, and gingiva have been reported in the past. This is the first case report of amlodipine induced plasma cell granuloma of the gingiva in the medical literature presenting a 54 year-old female patient with hypertension, who received amlodipine (10 mg/day, single dose orally) for 2 years, sought medical attention because of developing maxillary anterior massive gingival overgrowth causing functional and esthetic problem, which was treated by excisional biopsy. Histologically, these lesions were composed of mature plasma cells, showing polyclonality for both lambda and kappa light chains and fibrovascular connective tissue stroma confirming a diagnosis of plasma cell granuloma. This case also highlights the need to biopsy for unusual lesions to rule out potential neoplasms.

Benign fibroushistiocytoma of the gingiva

Benign fibroushistiocytoma is a benign connective tissue tumor rarely seen affecting the head and neck region. These tumors were believed to be of histiocytic origin as they are comprised of cells, which showed spindled morphology and cells with a round histiocytic appearance. The current concept consents that the lesional cells rather represent a fibroblastic differentiation. Diagnosis of these tumors proves to be challenging even with the use of immunohistochemistry due to lack of any specific markers. Here, we describe a case which presented in the gingiva mimicking a reactive lesion, which in fact was a tumor.

Reactive lesions of oral cavity: A survey of 100 cases in Eluru, West Godavari district

Aim:

Reactive lesions of the oral cavity are associated with injuries of soft tissue and have high prevalence rates and different involvement patterns in different parts of the world. This study reviews the pathogenesis and analyzes demographic data, histopathological features and compares the clinico-pathologic profiles of the diseases to those previously reported.

Materials and Methods:

Patient records of the Department of Oral Pathology during one and half year period were reviewed for diagnosis of oral connective tissue reactive hyperplastic lesion. Data including the area involved and the type of lesion were collected and analyzed using descriptive statistical methods and ANOVA test.

Results:

100 cases (mean age 36 years, male:female ratio 1:2) matched study criterion. The most common affected site was mandibular anterior region and buccal mucosa and the most common lesion was pyogenic granuloma and focal fibrous hyperplasia. All the lesions were more common in the mandible than in the maxilla. PGCG was seen to be equally distributed in males and females.

Conclusion:

Reactive hyperplastic lesions of the oral connective tissue are more common in females and the majority of the lesions occur in gingiva. This study supports previous assertions that PG and FFH may occur on any oral mucosal site with special preference for the mandibular anterior gingiva and buccal mucosa while PGCG and POF occur exclusively on the mandibular gingiva.

Nodular fasciitis of the oral cavity with partial spontaneous regression (nodular fasciitis)

Nodular fasciitis is a lesion found in the subcutaneous fascia that micoscopically presents as a benign proliferation of fibroblasts and myofibroblasts, which may be mistaken for a sarcoma due to clinically rapid growth. Diagnosis is by histopathology and of the immunohistochemical profile. We describe a case of nodular fasciitis in the oral cavity that demonstrated partial spontaneous regression. The patient was a 32-year-old man with a buccal mucosal mass, which had grown rapidly for 45 days. On microscopic examination, the lesion displayed a well-delineated but not encapsulated proliferation of spindle cells, with a nodular growth pattern. Immunohistochemical analysis showed positivity of the spindle cells for the antibodies against smooth muscle actin and muscle-specific actin (HHF-35). Treatment of such lesions typically involves complete conservative excision, but the lesion may regress eventually in the absence of definitive treatment.

Focal fibrous overgrowths: a case series and review of literature

Intraoral fibrous overgrowths of the soft tissues are relatively common and may be benign reactive or neoplastic lesions. A series of 10 lesions is presented which included pyogenic granuloma, fibroma and peripheral ossifying fibroma. Almost all the lesions occurred in the second and third decades and were present in the anterior segment of the jaws, with a distinct female predilection. Majority of these lesions were asymptomatic and the patients reported for treatment only due to the discomfort during function. Histopathologic examinations were done for diagnosis of these lesions. Surgical excision along with removal of causative irritants remains the treatment of choice. The extent of excision should depend on the severity of the lesion, as some of these lesions have a tendency for recurrence. All the patients in this series were closely followed up for a period of 2 years and showed no signs of recurrence.